Considerations when developing an emergency action plan

Plans can be considered in terms of pre-participation, during participation and post- participation for both training, and home or away match venues.

Equipment / Travel / Staffing/ Insurance

Establishing the minimum standards of medical equipment that will be available at training venues, pitch side and to travel with players to away venues is very important, as are responsibilities for checking and maintaining equipment. Standards may be strongly influenced by governing body directives, or medical evidence. Some of the equipment can be bulky e.g. long spine boards or hazardous to store and during travel e.g. oxygen bottles, so decisions need to be made about their usefulness in all settings and the ability to source locally, if travelling.

An example of minimum standards of medical equipment can be found in appendix one.

Local medical support

Although serious injury is uncommon in contact/collision sports such as rugby, having knowledge of the facilities at local hospitals and of the medical assistance / extrication team at the ground can be invaluable. An appreciation that a local hospital does not have specialist neurosurgical services or 24hr imaging may influence the decision on where to send an injured player.

Examples of the sort of information that may be useful to establish as part of emergency planning is as follows.

Match day Situations - Home and Away Venues

Although information is provided, pre-departure protocols should include all medical staff being aware of the following at home and away venues:

• position of medical room.
• exit routes from pitch to medical room (no stairs for stretchers)
• exit routes from medical room to ambulance transport
• approximate transfer times to local hospitals and contact details.

Medical Facilities

• site
• access
• capacity of medical room
• equipment present
• support medical staff – speciality?/experience?
• lighting/running water/waste disposal
• imaging.

Equipment

• Is it present?
• Is it appropriate?
• Are you familiar with it?
• Are oxygen cylinders full?
• Do AEDs have working batteries/‘in-date’ pads?
• Do suction units etc. work?
• Oxygen availability? When travelling abroad, have you sourced oxygen for both training and match situations?

Match day Support

• Who is available e.g. paramedic, specialist medical support?
• Have you met them and discussed roles?
• Do they have any signals for assistance?
• Where will they take any injuries – medical room or ambulance?

Geography

• Where is the nearest hospital?
• What is the transfer time?
• Does it have the relevant specialities on site, e.g. neurosurgery/orthopaedics/emergency medicine?

Training Facilities

Training facilities tend to be more spread out and be a greater distance from medical facilities than the match day situation. There are challenges about fewer trained responders and other staff for emergency situations, as well as communications and use of facilities away from formal sessions.

Areas that you may wish to consider when developing an emergency action plan are:

Venues

• Size of venue?
• Distance of remote areas from medical area?
• Communication from remote sites?
• Storage of emergency kit – ease of access for all?
• Signposting of emergency kit?
• Number of trained responders?
• Transport of large equipment such as a spine board to remote corners of site?
• Training and awareness for non-medical staff in event of incident?
• Criteria when ambulance help would be requested?
• Criteria when extrication to the medical room might be appropriate?
• Role of additional personnel to facilitate ambulance access.

Equipment

• Storage – battery operating temperatures (0 to 30 degrees) so be careful in extremes of weather – store in regulated temperatures
• Checks – suggest at least weekly checks of all equipment for training venues. Further checks before competitive events at training venues.
• Check for normal operation, expiry date and adequate supplies.
• Availability – ensure access codes to locked areas are available to all who may need them.

Medical information

Bearing in mind player consent, ensure all members of the medical team are aware of players and staff who have significant medical conditions e.g. asthma, diabetes or allergies such as bee stings. Include a management plan in the emergency action plan for these conditions e.g. ensure all staff have access to IM adrenaline and clearly defined criteria for transfer to hospital.